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  • Impact of the national home safety equipment scheme ‘Safe At Home’ on hospital admissions for unintentional injury in children under 5: a controlled interrupted time series analysis

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Original research
Impact of the national home safety equipment scheme ‘Safe At Home’ on hospital admissions for unintentional injury in children under 5: a controlled interrupted time series analysis
  1. Trevor Hill1,
  2. Carol Coupland1,
  3. Denise Kendrick1,
  4. Matthew Jones1,
  5. Ashley Akbari2,
  6. Sarah Rodgers3,
  7. Michael Craig Watson4,
  8. Edward Tyrrell1,
  9. Sheila Merrill5,
  10. Elizabeth Orton1
  1. 1 Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
  2. 2 Medical School, Swansea University, Swansea, UK
  3. 3 Public Health and Policy, University of Liverpool, Liverpool, UK
  4. 4 Institute of Health Promotion and Education, Lichfield, UK
  5. 5 Royal Society for the Prevention of Accidents (RoSPA), Edgbaston, UK
  1. Correspondence to Dr Elizabeth Orton, University of Nottingham, Nottingham NG72RD, UK; elizabeth.orton{at}nottingham.ac.uk

Abstract

Background Unintentional home injuries are a leading cause of preventable death in young children. Safety education and equipment provision improve home safety practices, but their impact on injuries is less clear. Between 2009 and 2011, a national home safety equipment scheme was implemented in England (Safe At Home), targeting high-injury-rate areas and socioeconomically disadvantaged families with children under 5. This provided a ‘natural experiment’ for evaluating the scheme’s impact on hospital admissions for unintentional injuries.

Methods Controlled interrupted time series analysis of unintentional injury hospital admission rates in small areas (Lower Layer Super Output Areas (LSOAs)) in England where the scheme was implemented (intervention areas, n=9466) and matched with LSOAs in England and Wales where it was not implemented (control areas, n=9466), with subgroup analyses by density of equipment provision.

Results 57 656 homes receiving safety equipment were included in the analysis. In the 2 years after the scheme ended, monthly admission rates declined in intervention areas (−0.33% (−0.47% to −0.18%)) but did not decline in control areas (0.04% (−0.11%–0.19%), p value for difference in trend=0.001). Greater reductions in admission rates were seen as equipment provision density increased. Effects were not maintained beyond 2 years after the scheme ended.

Conclusions A national home safety equipment scheme was associated with a reduction in injury-related hospital admissions in children under 5 in the 2 years after the scheme ended. Providing a higher number of items of safety equipment appears to be more effective in reducing injury rates than providing fewer items.

  • accidents
  • epidemiology
  • injury
  • public health

Data availability statement

Data may be obtained from a third party and are not publicly available. The data used in this study are available in the SAIL Databank at Swansea University, Swansea, UK, but as restrictions apply, they are not publicly available. All proposals to use SAIL data are subject to review by an independent Information Governance Review Panel (IGRP). Before any data can be accessed, approval must be given by the IGRP. The IGRP gives careful consideration to each project to ensure proper and appropriate use of SAIL data. When access has been granted, it is gained through a privacy protecting safe haven and remote access system referred to as the SAIL Gateway. SAIL has established an application process to be followed by anyone who would like to access data via SAIL at https://www.saildatabank.com/application-process. The HES Data (copyright 2021) was reused with the permission of the Health and Social Care Information Centre. All rights reserved. Data sharing agreement number DARS-NIC-50919-D5R5D-V1.4.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/jech-2021-216613

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The data used in this study are available in the SAIL Databank at Swansea University, Swansea, UK, but as restrictions apply, they are not publicly available. All proposals to use SAIL data are subject to review by an independent Information Governance Review Panel (IGRP). Before any data can be accessed, approval must be given by the IGRP. The IGRP gives careful consideration to each project to ensure proper and appropriate use of SAIL data. When access has been granted, it is gained through a privacy protecting safe haven and remote access system referred to as the SAIL Gateway. SAIL has established an application process to be followed by anyone who would like to access data via SAIL at https://www.saildatabank.com/application-process. The HES Data (copyright 2021) was reused with the permission of the Health and Social Care Information Centre. All rights reserved. Data sharing agreement number DARS-NIC-50919-D5R5D-V1.4.

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    Footnotes

    • Twitter @AshleyAkbari, @GeographySarah, @InstituteHPE

    • Contributors EO, DK, CC, ET, MJ, SR, SM and MCW designed and obtained funding for the study. TH undertook the analysis in consultation with all authors and provided additional advice on methods. AA provided expert advice regarding information governance and data management. All authors contributed to the manuscript. EO took overall responsibility for the study.

    • Funding Time for SR to contribute to this project was funded by The National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC).

    • Disclaimer The views expressed here are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The funder had no input in the study.

    • Competing interests Authors MCW, CC and DK previously evaluated the Safe At Home scheme in a study funded by RoSPA and published in 2011: https://www.rospa.com/rospaweb/docs/advice-services/home-safety/final-evaluation-report-safe-at-home.pdf. RoSPA received funding from the UK government to manage and implement the Safe At Home scheme. They provided an advisory role in this study and did not directly analyse the data.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.